Provider Demographics
NPI:1821417858
Name:LUXENBURG, RANDI (DMD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:LUXENBURG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 95TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:917-519-4068
Mailing Address - Fax:
Practice Address - Street 1:4422 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-618-8961
Practice Address - Fax:718-960-9350
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program